Talent.com
Lead EDI Specialist (Hybrid)
Lead EDI Specialist (Hybrid)Serigor Inc. • Philadelphia, PA, US
Lead EDI Specialist (Hybrid)

Lead EDI Specialist (Hybrid)

Serigor Inc. • Philadelphia, PA, US
3 days ago
Job type
  • Full-time
  • Quick Apply
Job description

Job Title :

  • Lead EDI Specialist (Hybrid) Location : Philadelphia, PA Duration : 3-6 Months Responsibilities : Lead reconciliation efforts for Core Enrollment Operations to ensure that key systems are updated.
  • Review complex inbound 834 and alt 834 file issues in pre-edit / post-release to develop best practices for analysis, reconciliation, and resolution.
  • Responsible for identifying process improvement opportunities that can enhance quality and efficiency without sacrificing service.
  • Liaison between Core Enrollment Operations and Vendors / UST / SDS / BTS / Compliance / Marketing / Client Implementation for enrollment impacting initiatives.
  • Act as subject matter expert for group requests and coordinate technical / process changes.
  • Document / prioritize system limitations and coordinate with BTS to identify technical solutions or automation opportunities.
  • Successfully manage the flow of inbound EDI files for client business.
  • Develop and document procedures / job aides / service alerts / policies for enrollment processes.
  • Manage initial enrollment file loads for new client installations.
  • Assist and train team members as needed.
  • Manage team inventory activity.
  • Lead enrollment related issues resolution for Enrollment Resolver Group.
  • Organize / disperse team project work for other team members.
  • Work on ad-hoc projects as requested.
  • Responsible for managing all robotic process automation (RPA) work for the business area.
  • Other duties assigned by the Leadership Team.

Knowledge, Skills, Abilities :

  • Ability to work and coordinate enrollment process and Analytics for Core Enrollment Operations.
  • Represent Core Enrollment Operations during customer integration projects, operational meetings between IBC divisions, new implementations, integration and new product development, key control audits, regulatory examinations, interaction with Health Edge (or other vendors).
  • Acute knowledge of EDI & enrollment systems.
  • Understanding of XML / ANSI 834 / HIPAA X12 transactions is required.
  • Must possess the ability to interface with internal / external customers at various levels.
  • Demonstrate experience in training & development.
  • Willingness to work in a fast-paced, challenging environment.
  • Detail oriented and organized, with exceptional prioritization skills.
  • Ability to effectively communicate with senior management, supervisors, peers, and clients.
  • Proficient in Microsoft Applications.
  • Proven process improvement methodology and driving change management.
  • Requires an extensive knowledge of EDI Portal functionality and managing inbound EDI enrollment file activity.
  • Experience in the Health Rules system platform, understanding of the Front Office System and how these platforms interact with EDI Portal for EDI enrollment validation preferred but not required.
  • Education & Experience :

  • BA / BS Degree in Business related field or equivalent work experience preferred.
  • Minimum of 5 years’ experience in healthcare.
  • Scope :

  • Has in-depth knowledge in own discipline and basic knowledge of related disciplines.
  • Solves complex problems; takes a new perspective on existing solutions.
  • Works independently; receives minimal guidance.
  • Resource for colleagues with less experience.   Powered by JazzHR
  • Create a job alert for this search

    Edi Specialist • Philadelphia, PA, US

    Related jobs
    Scala Team Lead

    Scala Team Lead

    VirtualVocations • Hamilton, New Jersey, United States
    Full-time
    A company is looking for a Scala Team Lead.Key Responsibilities Drive the definition and implementation of new architecture for long-term scalability and efficiency Act as a mentor to employees,...Show more
    Last updated: 3 days ago • Promoted
    Senior ETL Developer

    Senior ETL Developer

    VirtualVocations • Philadelphia, Pennsylvania, United States
    Full-time
    A company is looking for a Senior ETL Developer to join their team.Key Responsibilities Design, create, and enhance EDI and ETL processes to support internal teams and business functions Adminis...Show more
    Last updated: 23 days ago • Promoted
    Lead Test Design Engineer

    Lead Test Design Engineer

    VirtualVocations • Hamilton, New Jersey, United States
    Full-time
    A company is looking for a Lead Test Design Professional.Key Responsibilities Serve as technical QE lead for Data Collection Modules for the EnergyIP product Develop complex project test strateg...Show more
    Last updated: 2 days ago • Promoted
    QA Specialist - 21 CFR Part 11

    QA Specialist - 21 CFR Part 11

    VirtualVocations • Hamilton, New Jersey, United States
    Full-time
    A company is looking for MES Testing Staff for Ignition Track & Trace in a remote setting.Key Responsibilities : Design, develop, and execute comprehensive test cases for Ignition Track & Trace wo...Show more
    Last updated: 3 days ago • Promoted
    Lead EDI Specialist

    Lead EDI Specialist

    Innova Solutions • Philadelphia, PA,Pennsylvania,United States
    Full-time
    Quick Apply
    A client of Innova Solutions is hiring for a.Position type : Full time - Contract.Lead reconciliation efforts for Core Enrollment Operations to ensure that key systems are updated.Review complex inb...Show more
    Last updated: 3 days ago
    Pharmacy EDI Specialist

    Pharmacy EDI Specialist

    VirtualVocations • Hamilton, New Jersey, United States
    Full-time
    A company is looking for a Payer EDI Pharmacy Specialist to support healthcare data exchange initiatives.Key Responsibilities Serve as the expert on National Council for Prescription Drug Program...Show more
    Last updated: 2 days ago • Promoted
    Senior Product Integration Lead

    Senior Product Integration Lead

    VirtualVocations • Hamilton, New Jersey, United States
    Full-time
    A company is looking for a Senior Product Integration Lead, Partner Platforms and GenAI.Key Responsibilities Drive technical integration of Generative AI offerings with ISV and CSP platforms, def...Show more
    Last updated: 3 days ago • Promoted
    Lead Generation Specialist

    Lead Generation Specialist

    VirtualVocations • Hamilton, New Jersey, United States
    Full-time
    A company is looking for a Lead Generation Representative to join their sales team.Key Responsibilities Generate sales qualified leads through various channels and outbound prospecting Research ...Show more
    Last updated: 30+ days ago • Promoted
    Lead Solutions Consultant

    Lead Solutions Consultant

    VirtualVocations • Hamilton, New Jersey, United States
    Full-time
    A company is looking for a Lead Solutions Consultant focused on Customer Success.Key Responsibilities Drive customer value realization by assessing platform usage and creating actionable optimiza...Show more
    Last updated: 30+ days ago • Promoted
    Senior Enterprise Deployment Lead

    Senior Enterprise Deployment Lead

    VirtualVocations • Philadelphia, Pennsylvania, United States
    Full-time
    A company is looking for a Senior Enterprise Deployment Program Technical Lead.Key Responsibilities : Architect and implement BYOC solutions for enterprise customers on Microsoft Azure and Google ...Show more
    Last updated: 3 days ago • Promoted
    Dev Lead - Data Integration

    Dev Lead - Data Integration

    VirtualVocations • Hamilton, New Jersey, United States
    Full-time
    A company is looking for a Dev Lead / Scrum - Data & Integration to oversee secure data exchange and analytics solutions for a Department of Defense enterprise system. Key Responsibilities Lead Agil...Show more
    Last updated: 4 days ago • Promoted
    Data Integration Lead

    Data Integration Lead

    VirtualVocations • Hamilton, New Jersey, United States
    Full-time
    A company is looking for a Data Integration Lead.Key Responsibilities Oversee the integration of data across various systems and platforms Develop and implement data integration strategies and b...Show more
    Last updated: 30+ days ago • Promoted
    Shop and Deliver - No Experience Required

    Shop and Deliver - No Experience Required

    Instacart Shoppers • Batsto, NJ, US
    Part-time
    Start earning quickly with a flexible schedule.Shopping with Instacart is more than grocery delivery.Shoppers help make our world go round. They make money, make moves, and make shopping lists come ...Show more
    Last updated: 3 days ago • Promoted
    Integration Project Team Lead

    Integration Project Team Lead

    VirtualVocations • Hamilton, New Jersey, United States
    Full-time
    A company is looking for an ADP Integration Office Integration Project Team Lead - Level 4.Key Responsibilities Coordinate support from all program and sustainment areas to achieve desired result...Show more
    Last updated: 3 days ago • Promoted
    ERA / EFT Enrollment Specialist

    ERA / EFT Enrollment Specialist

    VirtualVocations • Philadelphia, Pennsylvania, United States
    Full-time
    A company is looking for an ERA / EFT Enrollment Specialist who will manage the automated receipt of payments and Explanations of Benefits (EOBs) from payers. Key Responsibilities Review incoming pa...Show more
    Last updated: 2 days ago • Promoted
    Senior Contracts Specialist

    Senior Contracts Specialist

    VirtualVocations • Hamilton, New Jersey, United States
    Full-time
    A company is looking for a Contracts Specialist, Senior Consultant.Key Responsibilities : Provide full lifecycle acquisition support, including planning, solicitation, evaluation, award, and post-...Show more
    Last updated: 30+ days ago • Promoted
    Network Product Lead

    Network Product Lead

    VirtualVocations • Hamilton, New Jersey, United States
    Full-time
    A company is looking for a Network Product Lead (CPO).Key Responsibilities Engineer the network as a product, continuously designing interventions to enhance performance Own the unified portfoli...Show more
    Last updated: 6 days ago • Promoted
    Workday Projects Lead

    Workday Projects Lead

    VirtualVocations • Hamilton, New Jersey, United States
    Full-time
    A company is looking for a Workday Projects & Assets Lead to oversee the configuration, implementation, and management of Workday Financials and Assets modules. Key Responsibilities Serve as the f...Show more
    Last updated: 4 days ago • Promoted